OP0055 ASAS CONSENSUS DEFINITION OF EARLY AXIAL SPONDYLOARTHRITIS
Authors: V. Navarro-Compán, D. Benavent, D. Capelusnik, D. Van der Heijde, R. B. M. Landewé, D. Poddubnyy, A. Van Tubergen, X. Baraliakos, F. Van den Bosch, F. A. Van Gaalen, L. S. Gensler, C. López-Medina, H. Marzo-Ortega, A. Moltó, R. Perez Alamino, M. Rudwaleit, M. G. H. Van de Sande, R. Sengupta, U. Weber, S. Ramiro
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> There is a growing interest in understanding the early disease stages of axial and peripheral SpA (axSpA and pSpA). In order to facilitate this, standardized definitions are needed for research purposes. <h3>Objectives</h3> To develop a consensual definition for the terms "early axSpA" and "early pSpA" in the research setting under the auspices of the Assessment of SpondyloArthritis international Society (ASAS). <h3>Methods</h3> The ASAS-SPEAR (SPondyloarthritis EARly definition) steering committee convened an international working group (WG). Five consecutive steps were followed: i) Systematic literature review (SLR) to identify existing definitions of early axSpA/pSpA and to summarize the evidence on the relationship between early treatment and clinical response in SpA<sup>[1,2]</sup>; ii) Discussion of SLR results within the WG and ASAS community (2022 annual meeting); iii) A three-round Delphi survey (Apr-Nov 2022) inviting all ASAS members to select the items that should be considered for the definition of the terms (using a Likert scale 1-9). In total, 20 items relating to three different aspects (axial symptoms, duration of symptoms and radiographic damage involvement) were voted on. Consensus was defined as acceptance or rejection if ≥70% of responses fell within 7-9 or 1-3 on the Likert scale, respectively; iv) Presentation of Delphi survey results to the WG and later to the ASAS community; v) Final discussion, voting and endorsement by ASAS members (2023 annual meeting). <h3>Results</h3> After discussing the results of the SLR<sup>[1,2]</sup> (step i) with the ASAS community, consensus was to proceed with an expert-based consensual definition for early axSpA (81% full ASAS members voted in favor) but not for pSpA (54% voted against) (step ii). Importantly, it was decided that the definition should be based on the symptom duration (91% in favor) taking solely axial symptoms into account (77% in favor). A total of 151-164/209 (72-78%) ASAS members participated in the Delphi survey rounds (step iii). Consensus was achieved to define early axSpA as a duration of symptoms of ≤2 years. Relating to axial symptoms, consensus was reached for acceptance of 6 items (axial symptoms should include cervical pain, thoracic pain, back pain, buttock pain and morning stiffness and be defined by a rheumatologist) and rejection of 2 items (should not include shoulder pain and hip pain). In addition, consensus was achieved to define early axSpA regardless of the presence/absence of radiographic damage (Table 1). Following the discussion of the Delphi survey results the WG agreed that in patients with a diagnosis of axSpA <b>"early axSpA" should be defined as a duration of ≤2 years of axial symptoms. Axial symptoms should include spinal/buttock pain or morning stiffness and should be considered by a rheumatologist as related to axSpA, Figure 1.</b> The WG proposal was discussed and endorsed by the ASAS community with 88% full ASAS members voting in favor (step v). <h3>Conclusion</h3> Early axSpA has for the first time been defined based on expert consensus. This ASAS definition should be used in research studies addressing early axSpA. <h3>References</h3> [1]Benavent D, et al. Semin Arthritis Rheum. 2022 Aug; 55:152032. [2]Capelusnik D, et al. Rheumatology (Oxford). 2022 Sep 13:keac532.doi:10.1093. <h3>Funding</h3> The Assessment of Spondyloarthritis international Society (ASAS) supported the ASAS- SPEAR (ASAS-SPondyloarthritis EARly definition) project. <h3>Acknowledgements</h3> The Assessment of Spondyloarthritis international Society (ASAS) supported the ASAS- SPEAR (ASAS-SPondyloarthritis EARly definition) project. <h3>Disclosure of Interests</h3> Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharm, Consultant of: AbbVie, Eli Lilly, Galapagos, MoonLake, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis, Diego Benavent Consultant of: Janssen, Abbvie, and Galapagos, Grant/research support from: Novartis, Dafne Capelusnik: None declared, Désirée van der Heijde Shareholder of: Director of Imaging Rheumatology bv, Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Robert B.M. Landewé Shareholder of: Director of Rheumatology Consultancy BV, Consultant of: Consulting fees from AbbVie, Eli-Lilly, Janssen, Galapagos, Gilead, Novartis, Pfizer, UCB., Denis Poddubnyy Speakers bureau: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, UCB, Consultant of: AbbVie, Biocad, BMS, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Samsung Bioepis, UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Astrid van Tubergen Speakers bureau: Pfizer, Consultant of: Novartis, Galapagos, UCB;, Grant/research support from: Pfizer, UCB, Novartis, Xenofon Baraliakos Speakers bureau: Abbvie, Amgen, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB., Consultant of: Abbvie, Amgen, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB., Grant/research support from: Abbvie, Amgen, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB., Filip van den Bosch Speakers bureau: speaker and/or consultancy fees from AbbVie, Amgen, Eli Lilly, Galapagos, Janssen, Moonlake, Novartis, Pfizer and UCB, Consultant of: speaker and/or consultancy fees from AbbVie, Amgen, Eli Lilly, Galapagos, Janssen, Moonlake, Novartis, Pfizer and UCB, Floris A. van Gaalen Consultant of: fees from MSD, fees from Abb Vie, fees from Bristol Myers Squibb., Grant/research support from: grants from Stichting vrienden van Sole Mio, grants from Stichting ASAS, grant from Jacobus Stichting,grants and fees from Novartis, grants from UCB, Lianne S. Gensler Consultant of: AbbVie, Acelyrin, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, UCB Pharma, Grant/research support from: UCB, Novartis, Clementina López-Medina Speakers bureau: AbbVie, Eli Lilly, Novartis, Janssen, UCB Pharma, Consultant of: Eli Lilly, Novartis, UCB Pharma, Helena Marzo-Ortega Speakers bureau: Speaker fees and/or consultancy: ABvie, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer and UCB., Consultant of: Speaker fees and/or consultancy: ABvie, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer and UCB., Grant/research support from: Janssen, Novartis and UCB, Anna Moltó Consultant of: AbbVie, Biogen, BMS, Cyxone, Eisai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Grant/research support from: UCB, Rodolfo Perez Alamino Speakers bureau: Abbvie, Eli Lilly, Novartis, Janssen, Pfizer, Consultant of: Abbvie, Eli Lilly, Janssen, Novartis., Martin Rudwaleit Speakers bureau: AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer, UCB Pharma, Marleen G.H. van de Sande Speakers bureau: Janssen, Novartis, UCB, Consultant of: Abbvie, Eli Lilly, Novartis, UCB;, Grant/research support from: Eli Lily, Novartis, UCB, Raj Sengupta Speakers bureau: AbbVie, Biogen, Eli Lilly, MSD, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis, UCB, Ulrich Weber Speakers bureau: Novartis, Sofia Ramiro Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Sanofi, UCB, Grant/research support from: AbbVie, Galapagos, MSD, Novartis, Pfizer, U.